Development is about expanding the capabilities of the disadvantaged, thereby improving their overall quality of life. Based on this understanding, Maharashtra, one of India’s richest States, is a classic case of a lack of development which is seen in its unacceptably high level of malnutrition among children in the tribal belts. While the State’s per capita income has doubled since 2004 (the result of sustained high economic growth), its nutritional status has not made commensurate progress.
A comparison of nutrition indicators for children under five years, using the third and fourth rounds of the National Family Health Survey (NFHS) 2015–2016 and 2005-06, shows this: though stunting has declined from 46.3% to 34.4%, wasting rates have increased from 16.5% to 25.6%. Further, the underweight rate (36%) has remained static in the last 10 years. This is worse than in some of the world’s poorest countries — Bangladesh (33%), Afghanistan (25%) or Mozambique (15%). This level of poor nutrition security disproportionately affects the poorest segment of the population.
According to NFHS 2015-16, every second tribal child suffers from growth restricting malnutrition due to chronic hunger. In 2005, child malnutrition claimed as many as 718 lives in Maharashtra’s Palghar district alone. Even after a decade of double digit economic growth (2004-05 to 2014-15), Palghar’s malnutrition status has barely improved.
In September 2016, the National Human Rights Commission issued notice to the Maharashtra government over reports of 600 children dying due to malnutrition in Palghar. The government responded, promising to properly implement schemes such as Jaccha Baccha and Integrated Child Development Services to check malnutrition. Our independent survey conducted in Vikramgad block of the district last year found that 57%, 21% and 53% of children in this block were stunted, wasted and underweight, respectively; 27% were severely stunted. Our data challenges what Maharashtra’s Women and Child Development Minister Pankaja Munde said in the Legislative Council in March — that “malnutrition in Palghar had come down in the past few months, owing to various interventions made by the government.”
Stunting is caused by an insufficient intake of macro- and micro-nutrients. It is generally accepted that recovery from growth retardation after two years is only possible if the affected child is put on a diet that is adequate in nutrient requirements. A critical aspect of nutrient adequacy is diet diversity, calculated by different groupings of foods consumed with the reference period ranging from one to 15 days. We calculated a 24-hour dietary diversity score by counting the number of food groups the child received in the last 24 hours.
The eight food groups include: cereals, roots and tubers; legumes and nuts; dairy products; flesh foods; eggs; fish; dark green leafy vegetables; and other fruits and vegetables. And 26% and 57% of the children (83% put together) had a dietary diversity score of two and three, respectively, implying that they had had food from only two/three of the eight food groups.
In most households it was rice and dal which was cooked most often and eaten thrice a day. These were even served at teatime to the children if they felt hungry. There was no milk, milk product or fruit in their daily diets. Even the adults drank black tea as milk was unaffordable. Only 17% of the children achieved a minimum level of diet diversity — they received four or more of the eight food groups. This low dietary diversity is a proxy indicator for the household’s food security too as the children ate the same food cooked for adult members.
Such acute food insecurity in tribal households is due to a loss of their traditional dependence on forest livelihood and the State’s deepening agrarian crisis. Besides these, systemic issues and a weakening of public nutrition programmes have aggravated the problem. For example, 20% of tribal families did not receive rations (public distribution system) in Vikramgad (in Palghar) as they did not have a card.
Analysis of the State’s Budget shows that the nutrition expenditure as a percentage of the State Budget has drastically declined from 1.68% in 2012-13 to 0.94% in 2018-19, a pointer to the government’s falling commitment to nutrition. It is no wonder then that our survey data show that nutrition schemes are not having the desired impact.
It is time the government looks at the root cause of the issue and finds a sustainable solution for tackling malnutrition. This is possible only when the state focusses on inclusive development by creating employment opportunities for the marginalised which would improve their purchasing power and, in turn, reduce malnutrition.
Soumitra Ghosh teaches at the School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai. Sarika Varekar is a student at the same university
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